Probiotics Reduce Treatment-related Complications in Adult Colorectal Cancer Patients: A Systematic Review and Meta-Analysis
Description
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy and safety of probiotics as a therapeutic approach for managing colorectal cancer treatment-related complications. MEDLINE, EMBASE, and Scopus databases were searched. The Mantel-Haenszel model was applied for all outcomes. Ten RCTs with 1,276 patients were included. There was a significant decrease in the incidence of diarrhea (Odds Ratio [OR] 0.42; 95% CI 0.31 to 0.55; p < 0.001), surgical site infection (OR 0.44; 95% CI 0.22 to 0.89; p = 0.023), urinary infection (OR 0.43; 95% CI 0.20 to 0.91; p=0.028), pulmonary infection (OR 0.30; 95% CI 0.15 to 0.60; p<0.001), abdominal distention (OR 0.43; 95% CI 0.25 to 0.76; p=0.004), length of ATB therapy (Mean Difference [MD] -1.66 days; 95% CI -2.13 days to -1.19 days; p < 0.001), and duration of postoperative pyrexia (MD -0.80 days; 95% CI -1.38 days to - 0.22 days; p=0.007) in the probiotic group. Nevertheless, length of hospital stay, time to first defecation, and time to first solid diet, were not different between groups. Our findings suggest that probiotics is effective for managing treatment-related complications in patients diagnosed with colorectal cancer, with a lower rate of adverse events.
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Search Strategy Our systematic review and meta-analysis have been performed according to Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched MEDLINE, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from inception to May 18, 2023 for articles published in English using the following search strategy: (Lactobacillus OR Bifidobacterium OR microbiota OR "gastrointestinal microbiota" OR microbiome OR bacteria) AND ("colorectal cancer" OR "colorectal surgery" OR "rectal cancer" OR "colorectal carcinogenesis" OR "colon cancer" OR ileostomy OR "colorectal resection" OR CRC) AND (modulation OR Probiotics) AND (RCT OR random OR randomized OR clinical OR trial OR prospective). Data extraction was conducted independently by two authors, who collected the following information from each individual study: (1) study characteristics, including time of follow-up, sample size per group; and formulation of the intervention; (2) patient baseline characteristics, such as age (years), sex (female or male), and severity of disease; and (3) outcomes of interest. Statistical analysis Binary endpoints were analyzed using odds ratios (OR), while standardized mean differences (MD) were used for continuous outcomes, with 95% confidence intervals for both. We considered p-values <0.05 to be statistically significant. The Mantel-Haenszel random-effects model was applied for all outcomes. Statistical analysis was conducted using R Software version 4.3.1.(10). Heterogeneity was assessed using the I² statistics, with significant heterogeneity defined as I² > 25%.